In:
European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 21, No. Supplement_1 ( 2020-01-01)
Abstract:
The Trans aortic valve replacement( TAVR) is well established technique that is basically designed for patient with sever aortic stenosis with high surgical risk. We describe a TAVR procedure was complicated with valve dislodgment and treated without surgical intervention Case report 75 year old Female Patient hypertensive, diabetic, Hypothyroidism and Atrial Fibrillation on oral anticoagulation. Her transthoracic echocardiography(TTE) showed sever critical aortic valve stenosis and calculated aortic valve are was 0.6 cm² and Peak gradient is 68mmhg and mean 46 mmHg , sever Left ventricular dysfunction and estimated EF 25 % . The CT Aortogram showed The aortic annulus maximum transverse diameter measures was 30 mm and the anteroposterior diameter was 25 mm. The sinus of Valsalva measures 37 mm was Sino tubular junction measures 24 mm and the proximal ascending aorta measures 39 mm. There is no evidence of coronary artery disease by the CT coronary angiogram. Because of depressed LV function, it was decided to do the TAVR with ECMO (Extra Corporeal Membrane Oxygenation) support. Based on CT measurements, CoreValve29 was selected The native valve is pre dilated then CoreValve29 was advanced. Unfortunately valve was larger than the aortic annulus and during trial to valve deployment ( Fig A) ,valve jumped into proximal ascending aorta in opining position just few centimeters from coronary ostium ( Fig B). We advance balloon for maximum dilatation of core valve 29 to ensure fixation of valve in ascending aorta and complete opening of valve leaflets. A second smaller valve (coreValve26) was advanced through the dislodged valve and crossing through its leaflet of first core valve (which settled in aorta) and successfully reaches the aortic annulus and confirming proper positioning of the coreValve26 and then deployed safely The coreValve26 was deployed in acceptable position and coreValve29 was hooked and well-fixed to 26 valves in proximal ascending aorta (Fig C). Coronary flow was secured and confirmed by aortic root injection (Fig F). Patient kept supported on ECMO before and during the TAVR procedure. The patient tolerated the procedure and was stable hemodynamically throughout the procedure. Successful ECMO weaning and patient hemodynamically remained stable with Total bypass time on ECMO was 142 minutes. Post procedure chest X ray showed two corValves hooked together in aortic root and ascending aorta in (Fig D). Follow up TTE showed improved EF systolic LV function (EF 39 %). Normal functioning aortic valve prosthesis. Conclusion Up to our knowledge, this is the first case that valve dislodgment was treated percutaneously not required urgent surgical intervention. Although it is one case report, however it could open the ideas for new approach how to manage difficult cases with dislodged valve with percutaneous approach. Abstract 1644 Figure.
Type of Medium:
Online Resource
ISSN:
2047-2404
,
2047-2412
DOI:
10.1093/ehjci/jez319.1034
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2020
detail.hit.zdb_id:
2042482-6
detail.hit.zdb_id:
2647943-6
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